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Suspicious transaction report form}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid2182276 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2182276\charrsid16076644 Schedules}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid2182276 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6058268 {\fs24\lang2057\langfe1033\langnp2057\insrsid5773771 ______________________________________________________________________________ \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid5773771 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid5773771 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid5773771 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid5773771 REGULATIONS}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid5773771 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid5773771\charrsid5773771 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6058268 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 1.}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 }{ \fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid5773771 Title}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 - These regulations may be cited as the Financial Transactions Reporting (Forms) Regulations 2004. \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6058268 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 2. }{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid3351166 Inte}{ \fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 r}{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid3351166 pr}{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 etation}{ \fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 - In these regulations, unless the context otherwise requires - \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3351166 \par }\pard \ql \li720\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin720\itap0\pararsid1006888 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 "Act" means the Financial Transactions Reporting Act 2003. \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6058268 {\fs24\lang2057\langfe1033\langnp2057\insrsid3351166 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 3. }{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 Cash transaction re}{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid3351166\charrsid3351166 p}{ \fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 ort form}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 - A financial institution required to report any cash transaction under section 10(l)(a) of the Act, must use the form set out in Schedule 1 of these Regulations. \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3351166 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 4. }{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 Electronic funds transfer report form}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 - A financial institution required to report any electronic}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 funds transfer under sections 10(1)(b) or 10(1)(c) of the Act, must use the form set out in Schedule 2 of these Regulations, \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3351166 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 5.}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 }{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 Sus}{ \fs24\ul\lang2057\langfe1033\langnp2057\insrsid3351166\charrsid3351166 picious transaction rep}{\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid3351166 ort form}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 - (1) A financial institution required to report any suspicious transaction under sections 11 or 12 of the Act, must use the form set out in Schedule 3 of these Regulations.}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 (2)}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 A financial institution must in addition to completing the form set out in Schedule 3, provide the following information to the FIU - \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid12075216 {\fs24\lang2057\langfe1033\langnp2057\insrsid12075216 \par }\pard \ql \li720\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin720\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 (a)}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 }{ \fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 a copy of all records held by the financial institution concerning the transaction; \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid12075216 {\fs24\lang2057\langfe1033\langnp2057\insrsid12075216 \par }\pard \ql \li720\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin720\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 (b)}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 }{ \fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 without limiting the generality of paragraph (a): \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid997386 {\fs24\lang2057\langfe1033\langnp2057\insrsid997386 \par }\pard \ql \li1440\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin1440\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 (i) }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 the name, and all contact details held by the financial institution, of every person known to the financial institution to have been involved in the conduct of the transaction, including every person on whose behalf that transaction was conducted; and}{ \fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 \par }\pard \ql \li1440\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin1440\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 (ii) }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 the dates relevant to the transaction; \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid997386 {\fs24\lang2057\langfe1033\langnp2057\insrsid997386 \par }\pard \ql \li720\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin720\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 (c)}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 }{ \fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 if an account provided by the financial institution is }{\fs24\lang2057\langfe1033\langnp2057\insrsid14037927 relevant to the transaction,}{ \fs24\lang2057\langfe1033\langnp2057\insrsid997386 -}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14037927 {\fs24\lang2057\langfe1033\langnp2057\insrsid14037927\charrsid6058268 \par }\pard \ql \li1440\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin1440\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 (i) }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 the type and identifying number of any account used by the financial institution for that transaction; and}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 \par }\pard \ql \li1440\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin1440\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 (ii) }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 a copy of the information and documents required by section 4 of the Act to be obtained and kept by the financial institution in respect of customers of that account; and}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 \par }\pard \ql \li1440\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin1440\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 (iii) }{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 a copy of the document ary evidence that is mentioned in section 4 of the Act; and is a record (relating to that account) required by section 6 of the Act to be kept by the financial institution. \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14037927 {\fs24\lang2057\langfe1033\langnp2057\insrsid14037927 \par }\pard \ql \li6480\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin6480\itap0\pararsid1006888 {\fs24\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid6058268 P. Arere \par }\pard \ql \li5760\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin5760\itap0\pararsid997386 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6058268\charrsid14037927 Clerk of the Executive Council}{ \b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid14037927 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid997386 {\fs24\lang2057\langfe1033\langnp2057\insrsid997386 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid997386 __________}{\fs24\lang2057\langfe1033\langnp2057\insrsid6058268 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3082574 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid3082574\charrsid3082574 SCHEDULE 1}{\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid3082574 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6168492 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid6168492 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid3152108 {\*\xmlopen\xmlns1{\factoidname place}}C}{ \fs24\lang2057\langfe1033\langnp2057\insrsid3152108 ook Islands{\*\xmlclose} }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid3152108 F}{\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 inancial }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid3152108 I}{\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 ntelligence }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid3152108 U}{ \fs24\lang2057\langfe1033\langnp2057\insrsid3152108 nit}{\fs24\lang2057\langfe1033\langnp2057\insrsid6168492 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3152108 {\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 CASH TRANSECTION REPORT (CTR) NZ $10,000 OR MORE \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3152108 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 Please complete in }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid3152108 INK}{ \fs24\lang2057\langfe1033\langnp2057\insrsid3152108 and in }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid3152108 CAPITAL LETTERS}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3152108 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid9702107\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 Reporting of "significant" cash transactions is required by law under Section 10(1)(a) of the Financial Transactions Reporting Act 2003. Penalties exist for failure to report or to supply full and correct information.}{\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108 \trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 {\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid9702107\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 PART A \endash IDENTITY OF PERSON CONDUCTING THE SUSPICIOUS TRANSACTION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3152108\charrsid9702107 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt \clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 { \fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid9702107\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid209595\charrsid7740683 1}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid7740683 .}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid209595\charrsid7740683 Full name (title, given names and surname)}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid7740683 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 __________________________________________________________________________ \par __________________________________________________________________________ \par Also known as: _____________________________________________________________ \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 {\fs24\lang2057\langfe1033\langnp2057\insrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000 \pard\plain \ql \li0\ri360\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin360\lin0\pararsid209595\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid7740683 2. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 Date of birth: \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid7740683 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 ___________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid7740683 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 Day/Month/Year}{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid7740683 \cell }\pard \ql \li0\ri360\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin360\lin0\pararsid7740683\yts15 { \b\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 3. Country of birth \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 \par _______________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid7740683 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid7740683 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt \clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6516266\charrsid6516266 4. }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid6516266 Occupation, business or principal activity \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3675389\charrsid3675389 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6516266 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid6516266\charrsid6516266 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7154328\charrsid3675389 5. Business address} {\b\fs24\lang2057\langfe1033\langnp2057\insrsid12155266\charrsid3675389 (physical and PO Box)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3675389 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid12155266\charrsid3675389 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389 ___________________________________ PO Box: _______________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid12155266\charrsid3675389 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid12155266\charrsid3675389 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3431252\charrsid3675389 \par Country: ______________________________ Phone: _____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid3431252 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389\charrsid3431252 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3675389 6. Residential address (cannot be a PO Box)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389 \par __________________________________________________________________________ \par \par __________________________________________________________________________ \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389\charrsid15629076 Country: _____________________________ Phone: ______________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3675389\charrsid3675389 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15629076 7. NON RESIDENT \endash {\*\xmlopen\xmlns1{\factoidname place}}Cook Islands{\*\xmlclose} conduct address}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15629076\charrsid15629076 \par __________________________________________________________________________ \par \par __________________________________________________________________________ \par \par Country}{\fs24\lang2057\langfe1033\langnp2057\insrsid15629076 : ___________________________________ Phone: ________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15629076\charrsid15629076 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15629076 8. Give details if this person is a signatory to account affected by this transaction}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15629076\charrsid15629076 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15629076 Account Title/Name: ________________________________________________________ \par \par Account No: ________________________ Branch: _______________________________ \par \par Financial Institution: ________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid15629076\charrsid15629076 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9702107 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2436025 9. How was the identity of this person confirmed?}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2436025\charrsid2436025 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2436025 ID Type: __________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2436025 ID Number: _______________________________________________________________ \par \par Issuer: ____________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2436025\charrsid2436025 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7740683 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid8658510\charrsid8658510 10. Is a photocopy of ID document/s attached?}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }\pard\plain \qj \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\itap2\pararsid8658510\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510 \nestcell{\nonesttables \par }}\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510 {\*\nesttableprops \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft5\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth445\clshdrawnil \cellx450\nestrow}{\nonesttables \par }}\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11865281\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510\charrsid8658510 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7740683 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8658510 { \fs24\lang2057\langfe1033\langnp2057\insrsid7740683\charrsid3152108 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid1323608\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510 If more than one person involved please provide same details contained in Sections 1-11 for each person, where appropriate, and attach.}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid1277895\charrsid8658510 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid1277895 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl \brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8658510 {\fs24\lang2057\langfe1033\langnp2057\insrsid1277895 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid1323608\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8658510 PART B \endash DETAILS OF PERSON/ORGANISATION ON WHOSE BEHALF THE TRANSACTION WAS CONDUCTED (If applicable)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid1277895\charrsid8658510 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid1277895 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl \brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8658510 {\fs24\lang2057\langfe1033\langnp2057\insrsid1277895 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid1323608\charrsid1323608 11. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid1323608 Full name of person/organisation \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11302729\charrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid1323608 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid1323608\charrsid1323608 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid1277895 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt \brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10702053 {\fs24\lang2057\langfe1033\langnp2057\insrsid1277895 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid926266 12. Business address (physical and PO Box) \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11302729\charrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid926266 ____________________________________ PO Box: ______________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid926266 __________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid926266 Country: ____________________________ Phone: _______________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid926266\charrsid926266 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10702053 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt \brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10702053 {\fs24\lang2057\langfe1033\langnp2057\insrsid10702053 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid11604910 13. Occupation, business or principal activity}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid11604910\charrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11604910 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid11604910\charrsid11604910 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10702053 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt \brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10702053 {\fs24\lang2057\langfe1033\langnp2057\insrsid10702053 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2704958 14. Give details if this person is a signatory to account affected by this transaction}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid10702053 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2704958\charrsid2704958 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4681830 Account Title/Name: ________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid4681830\charrsid2704958 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2704958\charrsid2704958 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4681830 Account No: ____________________________ Branch: ___________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2704958 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4681830 \par Financial Institution:_________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid4681830\charrsid2704958 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2704958\charrsid2704958 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10702053 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10702053 {\fs24\lang2057\langfe1033\langnp2057\insrsid10702053 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid12206597\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid12206597 PART C \endash DETAILS OF THE TRANSACTION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid10702053\charrsid12206597 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10702053 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10702053 { \fs24\lang2057\langfe1033\langnp2057\insrsid10702053 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12206597\charrsid12206597 15. Date of transaction} {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid10702053\charrsid12206597 \par }{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12206597\charrsid12206597 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\itap2\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12206597\charrsid12206597 \nestcell{\nonesttables \par }}\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12206597\charrsid12206597 {\*\nesttableprops\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft5\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth445\clshdrawnil \cellx450\nestrow}{\nonesttables \par }}\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12206597\charrsid12206597 \par DAY MONTH YEAR}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12206597 \par \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12206597\charrsid12206597 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10702053 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14956581 {\fs24\lang2057\langfe1033\langnp2057\insrsid10702053 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 16. Total amount of his transaction (include cash and any other components of the transaction \endash If a foreign currency is involved, convert the amount to {\*\xmlopen\xmlns1{\factoidname place}}{\*\xmlopen\xmlns1{\factoidname country-region}} New Zealand{\*\xmlclose}{\*\xmlclose} dollars) \par \par }\pard \ql \li720\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin720\pararsid14956581\yts15 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 NZ$ ___________________, ________ \par }\pard \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14956581\charrsid14956581 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid14956581 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl \brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14956581 {\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid12086329 17. If a foreign currency was involved in this transaction, specify:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid12086329\charrsid12086329 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid12086329 Foreign Currency ___________________________________________________________ \par }{\lang2057\langfe1033\langnp2057\insrsid12086329 (eg Hong Kong Dollars)}{\lang2057\langfe1033\langnp2057\insrsid12086329\charrsid12086329 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid12086329 \par Foreign Currency Amount ____________________________________________________ \par }{\lang2057\langfe1033\langnp2057\insrsid12086329 (eg HKD$400,000)}{\lang2057\langfe1033\langnp2057\insrsid12086329\charrsid12086329 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid12086329\charrsid12086329 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid14956581 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14956581 {\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000 \pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12086329\charrsid12086329 18. Cash paid IN \par \par \cell }\pard \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid12086329\yts15 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12086329\charrsid12086329 19. Cash paid OUT \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\itap2\pararsid12086329\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12086329\charrsid12086329 \nestcell{\nonesttables \par }}\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12086329\charrsid12086329 {\*\nesttableprops\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft5\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil \cellx510\nestrow}{\nonesttables \par }}\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000 \pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid12086329\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12086329\charrsid12086329 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid12086329 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000 \row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14956581 {\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 \par }\trowd \irow0\irowband0\ts15\trgaph108\trrh3050\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4158\clshdrawnil \cellx4050\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5041\clshdrawnil \cellx9091\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 20. Type of transaction(s) involved}{ \fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid15816423\charrsid12929661 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 Transfer to another }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 Financial Institution: }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 Travellers ch}{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 eques }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 Foreign curr}{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ency }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 Bank cheque}{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 Account depos}{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 it/withdrawal \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 Bank draft }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }\pard \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15816423\yts15 {\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 Securities \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 Previous stones/m}{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 etals/pearls etc }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par }\pard \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 {\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid12929661 \cell }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 \par \par ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 ________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid12929661 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid15816423 \trowd \irow0\irowband0\ts15\trgaph108\trrh3050\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4158\clshdrawnil \cellx4050\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5041\clshdrawnil \cellx9091\row }\trowd \irow1\irowband1\lastrow \ts15\trgaph108\trrh1305\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9199\clshdrawnil \cellx9091\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \par Other _____________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid15816423 \par }\pard \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15816423\yts15 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15816423\charrsid15816423 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid15816423 \trowd \irow1\irowband1\lastrow \ts15\trgaph108\trrh1305\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9199\clshdrawnil \cellx9091\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4734476 {\fs24\lang2057\langfe1033\langnp2057\insrsid14956581 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2389727 21. If a cheque/ bank draft/ money order/ telegraphic transfer/ transfer of currency or purchase or sale of any security was involved in this transaction, please specify:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4734476 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2389727\charrsid2389727 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2389727 Drawer/Ordering Customer: ___________________________________________________ \par ___________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11302729 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2389727 Payee/Favouree/Beneficiary: ___________________________________________________ \par ___________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2389727\charrsid2389727 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4734476 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid9897761 22. If another financial institution was involved in this transaction, please specify:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4734476 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9897761\charrsid9897761 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9897761 Name of financial institution: __________________________________________________ \par __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid9897761\charrsid9897761 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9897761 Branch: ____________________________________________________________________ \par \par Country: ___________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9897761\charrsid9897761 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4734476 { \fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid3152108 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid5970006\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid5970006 PART D \endash DETAILS OF THE RECIPIENT PERSON/ORGANISATION (if applicable)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid5970006 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4734476 {\fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3426556 23. Full name of person/organisation}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4734476 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3426556\charrsid3426556 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3426556 ___________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3426556\charrsid3426556 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4734476 { \fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid11544316 24. Business address (physical and PO Box)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4734476 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11544316\charrsid11544316 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11544316 _____________________________________ }{\fs24\lang2057\langfe1033\langnp2057\insrsid11544316\charrsid11544316 PO Box}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11544316 ______________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11544316 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid11544316\charrsid11544316 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11544316 \par Country: _____________________________ Phone: _______________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid11544316\charrsid11544316 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3426556 { \fs24\lang2057\langfe1033\langnp2057\insrsid4734476\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7941419 25. Occupation, business or principal activity}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3426556 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid7941419 \par ___________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid7941419 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid3426556\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7941419 { \fs24\lang2057\langfe1033\langnp2057\insrsid3426556\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6359229 26. Reason for transaction (eg payment for imports)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid7941419 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229\charrsid6359229 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229 ___________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229\charrsid6359229 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229 ___________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229\charrsid6359229 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7941419 { \fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6359229 27. Details of recipient account (if not already provided)}{\fs24\lang2057\langfe1033\langnp2057\insrsid7941419 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229 \par Account/Title/Name: _________________________________________________________ \par \par Account No: ___________________________ Branch: _____________________________ \par \par Financial Institution: _________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6359229\charrsid6359229 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7941419 { \fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid3152108 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15423647\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15423647 PART E \endash EXEMPLARY NOTES}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid15423647 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15423647 { \fs24\lang2057\langfe1033\langnp2057\insrsid7941419\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15423647 28. Give details of the nature and circumstances surrounding the transaction if required. PLEASE PRINT IN BLOCK LETTERS. \par \par ___________________________________________________________________________ \par ___________________________________________________________________________ \par ___________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid15423647 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15423647 { \fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid15423647\charrsid9247181 29. }{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid10886746\charrsid9247181 Is additional information attached to this report?}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid15423647\charrsid9247181 \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid10886746\charrsid9247181 \par \par \par Please specify}{\fs24\lang2057\langfe1033\langnp2057\insrsid10886746 : ______________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid10886746\charrsid10886746 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15423647 { \fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid3152108 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid10758179\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid10758179 PART F \endash REPORTING FINANCIAL INSTITUTION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid10758179 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10758179 {\fs24\lang2057\langfe1033\langnp2057\insrsid15423647\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid10758179 30. Type of Financial Institution (eg bank) \par \par ___________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid10758179 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10758179 { \fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid612703 31. Name of Financial Institution}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid10758179 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid612703\charrsid612703 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid612703 ___________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid612703\charrsid612703 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid10758179 { \fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid3152108 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid612703 32. Name of branch or office where transaction was conducted}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid10758179 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid612703 \par ___________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid612703\charrsid612703 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9247181 { \fs24\lang2057\langfe1033\langnp2057\insrsid10758179\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid9247181 33. }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11487077 Business address (physical and PO Box)}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid612703 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid11487077 \par _____________________________________ PO Box _____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2108075 _}{\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid11487077 \par \par __________________________________________________________________________ \par \par Country: _____________________________ Phone: _____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2108075 __}{\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid11487077 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid612703\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid11487077 { \fs24\lang2057\langfe1033\langnp2057\insrsid612703\charrsid3152108 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11487077\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid11487077 PART G \endash FINANCIAL INSTITUTIONS STATEMENT}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid11487077 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid11487077 {\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7936309 34. Details of authorised person:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11487077 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid7936309 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309 Given names and surname: ____________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid7936309 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309 ___________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid7936309 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309 Job title: ___________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid7936309 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309 \par Phone: __________________________________ Fax: ______________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid7936309 \par \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid11801273 { \fs24\lang2057\langfe1033\langnp2057\insrsid11487077\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid613697\charrsid11801273 35. }{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid11801273\charrsid11801273 This statement is made pursuant to the requirement that to report "significant" cash transactions under {\*\xmlopen\xmlns1{\factoidname place}}Cook islands{\*\xmlclose} laws on the grounds detailed in this report.}{ \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid7936309\charrsid11801273 \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid11801273\charrsid11801273 \par Signature of authorised person: \par \par \par \par Date:}{\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid11801273 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri360\widctlpar\wrapdefault\faauto\adjustright\rin360\lin0\itap0\pararsid4391756 { \fs24\lang2057\langfe1033\langnp2057\insrsid7936309\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15666155\charrsid11801273 36. }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 Financial Institutions internal reference number (if applicable)} {\b\fs24\lang2057\langfe1033\langnp2057\insrsid801449 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 \par ___________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid11801273 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid801449\charrsid11604910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9108\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid11801273 { \fs24\lang2057\langfe1033\langnp2057\insrsid801449\charrsid3152108 \par }\trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4398\clshdrawnil \cellx9090\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13768326\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 Send completed forms to:}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid15666155 \cell }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 For assistance contact:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid15666155 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid11604910 \trowd \irow0\irowband0 \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4398\clshdrawnil \cellx9090\row }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11801273\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 Head of FIU \par {\*\xmlopen\xmlns1{\factoidname address}}{\*\xmlopen\xmlns1{\factoidname Street}}PO Box{\*\xmlclose} 3219{\*\xmlclose} \par {\*\xmlopen\xmlns1{\factoidname place}}Rarotonga{\*\xmlclose} \par {\*\xmlopen\xmlns1{\factoidname place}}{\*\xmlopen\xmlns1{\factoidname PlaceName}}COOK{\*\xmlclose} {\*\xmlopen\xmlns1{\factoidname PlaceType}}ISLANDS}{\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid11801273 {\*\xmlclose}{\*\xmlclose}\cell } {\fs24\lang2057\langfe1033\langnp2057\insrsid13771395 Financial Intelligence Unit}{\fs24\lang2057\langfe1033\langnp2057\insrsid11801273 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13771395 Phone: (+682)29182 \par Fax: (+682)29183 \par Email: cifiu@oyster.net.ck}{\fs24\lang2057\langfe1033\langnp2057\insrsid13771395\charrsid11801273 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid11801273\charrsid11604910 \trowd \irow1\irowband1\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4398\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 \par }\pard \qc \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 ________}{\fs24\lang2057\langfe1033\langnp2057\insrsid15666155 \par }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid13771395 {\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 \par }\pard \qc \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid8522251\charrsid8522251 SCHEDULE 2}{\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid8522251 \par }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3702254 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid3702254 \par }\pard \qc \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 {\*\xmlopen\xmlns1{\factoidname place}}C}{ \fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 ook}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 I}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 slands}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 {\*\xmlclose} F}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 inancial }{ \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 I}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 ntelligence }{ \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 U}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid3702254\charrsid12854108 nit}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3702254\charrsid3702254 \par }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid8522251 \par }\pard \qc \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 ELECTRONIC TRANSFER REPORT (EFTR) \par }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 \par }\pard \qc \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8522251 {\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 Please complete in }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 INK }{ \fs24\lang2057\langfe1033\langnp2057\insrsid8522251\charrsid8522251 and in}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 CAPITAL LETTERS}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8522251\charrsid8522251 \par }\pard \ql \li0\ri0\widctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid13771395 {\fs24\lang2057\langfe1033\langnp2057\insrsid8522251\charrsid3152108 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \ql \li0\ri360\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin360\lin0\pararsid4391756\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid8522251 Reporting of electronic funds transfer, of over NZ$10,000, is required by law under Section 10(1)(b) and (c) of the Financial Transactions Reporting Act 2003. Penalties exist for failure to report or to supply full and correct information.}{ \fs24\lang2057\langfe1033\langnp2057\insrsid13771395\charrsid11801273 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \lang2057\langfe1033\langnp2057\insrsid13771395\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri360\nowidctlpar\wrapdefault\faauto\adjustright\rin360\lin0\itap0\pararsid4391756 { \fs24\lang2057\langfe1033\langnp2057\insrsid9702107 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\pard\plain \qc \li0\ri360\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin360\lin0\pararsid13120975\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid13120975 PART A \endash DETAILS OF THE TRANSACTION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13771395\charrsid13120975 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid13771395\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9198\clshdrawnil \cellx9090\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid13771395 { \fs24\lang2057\langfe1033\langnp2057\insrsid13771395 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9108\pard\plain \ql \li0\ri360\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin360\lin0\pararsid4391756\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid13120975 1. Initiating office/branch}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13771395 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13120975\charrsid13120975 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13120975 ________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid13120975\charrsid13120975 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13120975\charrsid13120975 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13771395\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9108\row }\pard \ql \li0\ri360\nowidctlpar\wrapdefault\faauto\adjustright\rin360\lin0\itap0\pararsid4391756 { \fs24\lang2057\langfe1033\langnp2057\insrsid13771395 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri360\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin360\lin0\pararsid4391756\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid13120975\charrsid12067947 2. Date of }{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12067947\charrsid12067947 -}{ \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid13120975\charrsid12067947 transmission/receipt}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13771395 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13120975 \par \par \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13120975\charrsid13120975 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13771395\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4391756\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid12067947 { \fs24\lang2057\langfe1033\langnp2057\insrsid13771395 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid12067947\charrsid15222186 3. Direction of transmission}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12067947 \par \par }{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid15222186\charrsid15222186 Into {\*\xmlopen\xmlns1{\factoidname place}}Cook islands}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12067947 {\*\xmlclose} \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12067947\charrsid12067947 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid12067947\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid12067947 { \fs24\lang2057\langfe1033\langnp2057\insrsid13771395 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15222186 4. Transaction reference reference number}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12067947 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15222186 \par __________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15222186\charrsid15222186 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid12067947\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 { \fs24\lang2057\langfe1033\langnp2057\insrsid12067947 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid16197324 5. Sending institutions details}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15222186 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324\charrsid16197324 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324 BIC (where applicable or) ____________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324\charrsid16197324 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324 Name of Bank: _____________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324\charrsid16197324 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324 \par City: ___________________________________ Country: __________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324\charrsid16197324 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16197324\charrsid16197324 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15222186\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15222186 { \fs24\lang2057\langfe1033\langnp2057\insrsid15222186 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid16197324\charrsid16197324 7. Date funds available}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15222186 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid16197324 \par \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid16197324\charrsid16197324 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15222186\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6297864 { \fs24\lang2057\langfe1033\langnp2057\insrsid15222186 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6957299 8. If a foreign currency was involved in this transaction, specify:}{\fs24\lang2057\langfe1033\langnp2057\insrsid6297864 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6957299 \par Currency __________________________________________________________________ \par }{\lang2057\langfe1033\langnp2057\insrsid6957299\charrsid6957299 (eg Hong Kong Dollars) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6957299 \par Amount of transaction _______________________________________________________ \par }{\lang2057\langfe1033\langnp2057\insrsid6957299 (eg HKD$400,000)}{\lang2057\langfe1033\langnp2057\insrsid6957299\charrsid6957299 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6957299\charrsid6957299 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid6297864\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6297864 { \fs24\lang2057\langfe1033\langnp2057\insrsid15222186 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7552504\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7552504 PART B \endash INVOVLED PARTY AND INSTITUTION DETAILS}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid6297864\charrsid7552504 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid6297864\charrsid11801273 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7755422 { \fs24\lang2057\langfe1033\langnp2057\insrsid6297864 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8808492 9. Ordering customer/organisation }{ \fs24\lang2057\langfe1033\langnp2057\insrsid8808492 (SWIFT field 50) \par \par Name: ____________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid8808492\charrsid8808492 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid8808492\charrsid11801273 \trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid15344671 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7755422\charrsid7755422 Occupation, business or principal activity: _____________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid7755422 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7755422\charrsid11801273 \trowd \irow1\irowband1\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid15344671 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7755422 Business/Residential address: \par (physical and PO Box) \par \par ______________________________________ PO Box: ____________________________ \par \par __________________________________________________________________________ \par \par Country: ________________________________ Phone: ___________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7755422\charrsid7755422 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7755422\charrsid11801273 \trowd \irow2\irowband2\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid15344671 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid1719604 Account details:}{\fs24\lang2057\langfe1033\langnp2057\insrsid15344671 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid1719604 \par Account Title/Name: ________________________________________________________ \par \par Bank: __________________________________ Branch: ___________________________ \par \par Account number: ___________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15344671 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15344671\charrsid11801273 \trowd \irow3\irowband3\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid1719604 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7759023 Person who authorised transfer:}{\fs24\lang2057\langfe1033\langnp2057\insrsid1719604 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par Title: _____________________________________________________________________ \par \par Name: ____________________________________________________________________ \par \par Position with organisation: ____________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid1719604 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid1719604\charrsid11801273 \trowd \irow4\irowband4\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv \brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7759023 { \fs24\lang2057\langfe1033\langnp2057\insrsid6297864 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7759023\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid1077792 10. Beneficiary Customer/organisation }{\fs24\lang2057\langfe1033\langnp2057\insrsid1077792 (SWIFT field 59)}{\fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid1077792 \par Name: ____________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid1077792\charrsid1077792 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7759023\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid13448747\charrsid13448747 Occupation}{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 , business or principal activity: _______________________________________ \par __________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747\charrsid13448747 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \trowd \irow1\irowband1\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7759023\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 Business/Residential address: \par (Physical and PO Box) \par \par _______________________________________ PO Box: ___________________________ \par \par __________________________________________________________________________ \par \par Country: _______________________________ Phone: ____________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747\charrsid13448747 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \trowd \irow2\irowband2\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7759023\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 Account details: \par \par Account Title/Name: ________________________________________________________ \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747\charrsid13448747 Bank}{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 : _________________________________ Branch: ____________________________ \par \par Account Number: ___________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747\charrsid13448747 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \trowd \irow3\irowband3\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7759023\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 Person identified to receive payment (if applicable) \par \par Title}{\fs24\lang2057\langfe1033\langnp2057\insrsid13055580 : _____________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13055580 Name: ____________________________________________________________________ \par \par Position with organisation: ____________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13055580 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13448747 \trowd \irow4\irowband4\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb \brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7759023 {\fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid7759023\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14366589 11. Sender's Correspondent }{ \fs24\lang2057\langfe1033\langnp2057\insrsid14366589 (SWIFT field 53)}{\fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14366589 \par Name of Bank: _____________________________________________________________ \par \par City: ___________________________________ Country: __________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14366589\charrsid14366589 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7759023 { \fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8734051 12. Receiver's Correspondent }{ \fs24\lang2057\langfe1033\langnp2057\insrsid8734051 (SWIFT field 54)}{\fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid8734051 \par Name of Bank: _____________________________________________________________ \par \par City: ___________________________________ Country: __________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid8734051\charrsid8734051 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid3811420\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3811420 PART C \endash ADDITIONAL PAYMENT DETAILS}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8332769\charrsid3811420 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid8332769 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid8332769 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6780142 13. Details of payment \par }{\lang2057\langfe1033\langnp2057\insrsid6780142\charrsid6780142 (}{\lang2057\langfe1033\langnp2057\insrsid6780142 SWIFT field 70 \endash information for the beneficiary customer regarding the payment eg. Invoice number) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6780142\charrsid6780142 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6780142 __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid6780142\charrsid6780142 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid6780142\charrsid6780142 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid6780142 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid6780142 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9008\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid4268897\charrsid7217558 14. Sender to Receiver information}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4268897 \par }{\lang2057\langfe1033\langnp2057\insrsid7217558\charrsid11212694 (}{\lang2057\langfe1033\langnp2057\insrsid11212694\charrsid11212694 SWIFT field 72 \endash Additional information for the receiving institution \endash also known as Bank to Bank information)}{\lang2057\langfe1033\langnp2057\insrsid4268897 \par }{\lang2057\langfe1033\langnp2057\insrsid11212694 \par _________________________________________________________________________________________ \par _________________________________________________________________________________________ \par _________________________________________________________________________________________ \par _________________________________________________________________________________________ \par _________________________________________________________________________________________ \par _________________________________________________________________________________________ \par _________________________________________________________________________________________}{\lang2057\langfe1033\langnp2057\insrsid11212694\charrsid11212694 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4268897\charrsid4268897 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid4268897 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9008\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid4268897 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14555128 15. Additional information (include Intermediary bank details, related reference number, ordering and beneficiary institutions \par }{\lang2057\langfe1033\langnp2057\insrsid14555128 \par (SWIFT field references \endash related reference number \endash 21, ordering institution \endash 52, intermediary \endash 56, beneficiary institution \endash 58)}{\fs24\lang2057\langfe1033\langnp2057\insrsid14555128 \par \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid14555128\charrsid14555128 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid14555128\charrsid14555128 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid14555128 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid14555128 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid752447 16. Any other information deemed relevant}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4990830 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid752447\charrsid752447 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14955560 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid752447 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14955560 __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid14955560\charrsid752447 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid752447\charrsid752447 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid4990830 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid4990830 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid13003128\charrsid13003128 17. Is additional information attached to this report? \par \par No Yes \par \par Please specify: _____________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________ \par __________________________________________________________________________}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13003128 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13003128\charrsid13003128 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13003128 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14162017 { \fs24\lang2057\langfe1033\langnp2057\insrsid13003128 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid14162017\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14162017 PART D \endash REPORTING FINANCIAL INSTITUTIONS}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid14162017\charrsid14162017 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid14162017 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4869008 { \fs24\lang2057\langfe1033\langnp2057\insrsid14162017 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid13006982 18. Type of Financial institution (eg bank)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid2385421 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid2385421 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4869008 { \fs24\lang2057\langfe1033\langnp2057\insrsid2385421 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 19. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid13006982 Name of Financial Institution \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13006982\charrsid13006982 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13006982 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4869008 { \fs24\lang2057\langfe1033\langnp2057\insrsid13006982 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid4869008 20. Name of branch or office where transaction was conducted}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid13006982 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008\charrsid4869008 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008\charrsid4869008 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008\charrsid4869008 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid13006982 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4869008 { \fs24\lang2057\langfe1033\langnp2057\insrsid13006982 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid4869008 21. Business address (physical and PO Box) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008\charrsid4869008 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008 _______________________________________ PO Box ___________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid10356962 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid10356962 Country: ______________________________ Phone: _____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid10356962\charrsid4869008 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4869008\charrsid4869008 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid4869008 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9580737 { \fs24\lang2057\langfe1033\langnp2057\insrsid4869008 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid9580737\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid9580737 PART E \endash FINANCIAL INSTITUTION'S STATEMENT}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid9580737\charrsid9580737 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid9580737 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid9580737 { \fs24\lang2057\langfe1033\langnp2057\insrsid9580737 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid9580737 22. Details of authorised person: \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9580737\charrsid9580737 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9727798 Given names and surname: ___________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid9580737 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9727798 __________________________________________________________________________ \par \par Job title: __________________________________________________________________ \par \par Phone: _______________________________ Fax: ________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid9727798\charrsid9580737 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid9580737\charrsid9580737 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid9580737 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid16350768 { \fs24\lang2057\langfe1033\langnp2057\insrsid9580737 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid16350768\charrsid5721245 23. This statement is made pursuant to the requirement to report suspicious transactions under}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid5721245\charrsid5721245 {\*\xmlopen\xmlns1{\factoidname place}}Cook Islands{\*\xmlclose} laws on the grounds detailed in Part E.}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid16350768\charrsid5721245 \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid5721245\charrsid5721245 \par Signature of authorised person: \par \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\itap2\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid5721245\charrsid5721245 \par Sign \par here \par \nestcell{\nonesttables \par }}\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid5721245\charrsid5721245 {\*\nesttableprops\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft5\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8877\clshdrawnil \cellx8882\nestrow}{\nonesttables \par }}\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid5721245\charrsid5721245 \par Date: \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid5721245\charrsid5721245 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid16350768 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3301845 { \fs24\lang2057\langfe1033\langnp2057\insrsid16350768 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid3301845 24. Financial Institutions internal reference number (if applicable) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3301845\charrsid3301845 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3301845 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid3301845\charrsid3301845 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid3301845\charrsid3301845 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid3301845 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3301845 { \fs24\lang2057\langfe1033\langnp2057\insrsid3301845 \par }\trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid1072273\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid1072273 Send completed forms to:}{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid1072273\charrsid1072273 \cell }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid1072273 For assistance contact:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid1072273\charrsid1072273 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid1072273 \trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt \brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid1072273\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\row }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid1072273\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid1072273 Head of FIU \par {\*\xmlopen\xmlns1{\factoidname address}}{\*\xmlopen\xmlns1{\factoidname Street}}PO Box{\*\xmlclose} 3219{\*\xmlclose} \par {\*\xmlopen\xmlns1{\factoidname place}}Rarotonga{\*\xmlclose} \par {\*\xmlopen\xmlns1{\factoidname place}}{\*\xmlopen\xmlns1{\factoidname PlaceName}}COOK{\*\xmlclose} {\*\xmlopen\xmlns1{\factoidname PlaceType}}ISLANDS}{\fs24\lang2057\langfe1033\langnp2057\insrsid1072273\charrsid1072273 {\*\xmlclose}{\*\xmlclose}\cell }{ \fs24\lang2057\langfe1033\langnp2057\insrsid10300473 Financial Intelligence Unit}{\fs24\lang2057\langfe1033\langnp2057\insrsid1072273 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid10300473 Phone: (+682)29182 \par Fax: (+682)29183 \par Email: cifiu@oyster.net.ck}{\fs24\lang2057\langfe1033\langnp2057\insrsid10300473\charrsid1072273 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid1072273 \trowd \irow1\irowband1\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid1072273\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\row }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid599434 {\fs24\lang2057\langfe1033\langnp2057\insrsid599434 ________}{\fs24\lang2057\langfe1033\langnp2057\insrsid3301845 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid599434 {\fs24\lang2057\langfe1033\langnp2057\insrsid599434 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid599434 SCHEDULE 3}{\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid7759023 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid599434 {\b\fs24\ul\lang2057\langfe1033\langnp2057\insrsid599434 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 {\*\xmlopen\xmlns1{\factoidname place}}C}{ \fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 ook}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 I}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 slands}{ \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 {\*\xmlclose} F}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 inancial}{ \b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 I}{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 ntelligence}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 U} {\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid599434\charrsid599434 nit}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid599434\charrsid599434 \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid599434 {\fs24\lang2057\langfe1033\langnp2057\insrsid599434\charrsid599434 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid599434 SUSPICIOUS TRANSACTION REPORT (STR) \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid599434 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid599434 \par }\pard \qc \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3082574 {\fs24\lang2057\langfe1033\langnp2057\insrsid599434\charrsid599434 Please complete in}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid599434 INK }{ \fs24\lang2057\langfe1033\langnp2057\insrsid599434\charrsid599434 and in}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid599434 CAPITAL LETTERS \par }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid599434 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid599434 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid4421157 Reporting of suspicious transactions is required by law under Section 11(1) of the Financial Transactions Reporting Act 2003. Penalties exist for failure to report or to supply full and correct information.}{\fs24\lang2057\langfe1033\langnp2057\insrsid599434 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid599434 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108 \trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4421157 { \fs24\lang2057\langfe1033\langnp2057\insrsid599434 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid4421157\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid4421157 PART A \endash IDENTITY OF PERSON CONDUCTING THE SUSPICIOUS TRANSACTION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4421157\charrsid4421157 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid4421157 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid4421157 { \fs24\lang2057\langfe1033\langnp2057\insrsid4421157 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14419122 1. Full name (title, given names and surname)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4421157 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14419122\charrsid14419122 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14419122 __________________________________________________________________________ \par __________________________________________________________________________ \par \par Also known as: _____________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid14419122\charrsid14419122 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14419122\charrsid14419122 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid4421157 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid2626722 { \fs24\lang2057\langfe1033\langnp2057\insrsid4421157 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2626722\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 2. Date of birth: \par ______________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 Day/Month/Year \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \cell }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 3. Country of birth: \par __________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2626722\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid2626722 {\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 4. Occupation, business or principal activity \par \par __________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid2626722 { \fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 5. Business address (physical and PO Box) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 ______________________________________ PO Box: ____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722 __________________________________________________________________________ \par Country: ______________________________ Phone: _____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2626722\charrsid2626722 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid2635366 { \fs24\lang2057\langfe1033\langnp2057\insrsid2626722 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid2635366 6. Residential address (cannot be a PO Box) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2635366 __________________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2635366\charrsid2635366 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2635366 __________________________________________________________________________ \par Country: _______________________________ Phone: ____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2635366\charrsid2635366 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2635366\charrsid2635366 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid2635366 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6178561 { \fs24\lang2057\langfe1033\langnp2057\insrsid2635366 \par }\trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid935017\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid6178561 7. }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid935017 NON RESIDENT \endash {\*\xmlopen\xmlns1{\factoidname place}}Cook Islands{\*\xmlclose} conduct address}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid6178561 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid935017 __________________________________________________________________________ \par __________________________________________________________________________ \par }\pard \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid935017\yts15 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid935017\charrsid6178561 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid6178561 \trowd \irow0\irowband0\ts15\trgaph108\trleft-108\trbrdrt \brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid935017\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\trowd \irow1\irowband1\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid935017\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt \clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid935017\charrsid935017 {\*\xmlopen\xmlns1{\factoidname place}}{\*\xmlopen\xmlns1{\factoidname PlaceName}}COOK{\*\xmlclose} {\*\xmlopen\xmlns1{\factoidname PlaceType}}ISLANDS{\*\xmlclose}{\*\xmlclose} \cell Phone: ___________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid935017 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid935017 \trowd \irow1\irowband1\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid935017\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4800\clshdrawnil \cellx4692\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4308\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14381256 {\fs24\lang2057\langfe1033\langnp2057\insrsid6178561 \par }\trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14381256 8. Give details if this person is a signatory to account affected by this transaction \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256\charrsid14381256 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256 Account Title/Name: ________________________________________________________ \par \par Account No. ____________________________ Branch: ____________________________ \par \par Financial Institution: ________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256\charrsid14381256 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256\charrsid14381256 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid14381256 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid14381256 { \fs24\lang2057\langfe1033\langnp2057\insrsid14381256 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid14381256 9. How was the identity of this person confirmed? \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256\charrsid14381256 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256 ID Type: __________________________________________________________________ \par \par ID Number: _______________________________________________________________ \par \par Issuer: ____________________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256\charrsid14381256 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid14381256\charrsid14381256 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid14381256 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15083792 { \fs24\lang2057\langfe1033\langnp2057\insrsid14381256 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid15083792\charrsid15083792 10. Is a photocopy of ID document/s attached? \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid15083792\charrsid15083792 \par Yes No}{\fs24\lang2057\langfe1033\langnp2057\insrsid15083792 }{\fs24\lang2057\langfe1033\langnp2057\insrsid15083792\charrsid15083792 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15083792\charrsid15083792 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15083792 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid6555507 { \fs24\lang2057\langfe1033\langnp2057\insrsid15083792 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11171859\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid6555507 If more than one person}{ \fs24\lang2057\langfe1033\langnp2057\insrsid11171859 involved please provide same details contained in Sections 1-11 for each person, where appropriate, and attach.}{\fs24\lang2057\langfe1033\langnp2057\insrsid6555507 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid6555507 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108 \trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid11171859 { \fs24\lang2057\langfe1033\langnp2057\insrsid6555507 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11171859\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid11171859 PART B \endash DETAILS OF PERSON/ORGANISATION ON WHOSE BEHALF THE TRANSACTION WAS CONDUCTED (if applicable)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid11171859\charrsid11171859 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid11171859 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108 \trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7954248 { \fs24\lang2057\langfe1033\langnp2057\insrsid11171859 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7954248 11. Full name of person/organisation }{\fs24\lang2057\langfe1033\langnp2057\insrsid11171859 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13115746 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7954248 __________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7954248\charrsid7954248 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid11171859 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid5118910 { \fs24\lang2057\langfe1033\langnp2057\insrsid11171859 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid5118910 12. Business address (physical and PO Box) \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid5118910\charrsid5118910 ______________________________________ PO Box: ___________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid5118910 \par \par __________________________________________________________________________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid13115746 \par Country: ______________________________ Phone: _____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid5118910\charrsid13115746 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid5118910\charrsid5118910 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid5118910 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid16347142 { \fs24\lang2057\langfe1033\langnp2057\insrsid5118910 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid16347142 13. Occupation, business or physical activity \par \par __________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid16347142\charrsid16347142 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid16347142 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid16347142 { \fs24\lang2057\langfe1033\langnp2057\insrsid16347142 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid16347142 14. Give details if this person is a signatory to account affected by this transaction \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16347142\charrsid16347142 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid8801437 Account Title/Name: ________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid16347142\charrsid16347142 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid8801437 Account No: ___________________________ Branch: ____________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid16347142\charrsid16347142 \par \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid8801437 Financial Institution: ________________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid16347142\charrsid16347142 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16347142\charrsid16347142 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid16347142 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid8801437 { \fs24\lang2057\langfe1033\langnp2057\insrsid16347142 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid8801437\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid8801437 PART C \endash DETAILS OF THE TRANSACTION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid8801437\charrsid8801437 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid8801437 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid3938156 { \fs24\lang2057\langfe1033\langnp2057\insrsid8801437 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15221821 15. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid1538459 Type of transaction (eg deposit)}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid3938156 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid1538459 \par __________________________________________________________________________ \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid1538459\charrsid15221821 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid3938156 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid1538459 { \fs24\lang2057\langfe1033\langnp2057\insrsid3938156 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid7933468\charrsid7933468 16. Date of transaction}{\b\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid1538459\charrsid7933468 \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid7933468\charrsid7933468 \par Day Month Year \par }{\fs24\lang2057\langfe1033\highlight4\langnp2057\insrsid7933468\charrsid7933468 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid1538459 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7933468 { \fs24\lang2057\langfe1033\langnp2057\insrsid1538459 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid7933468 17. Total amount of this transaction (include cash and any other components of the transaction \endash If a foreign currency is involved, convert the amount to {\*\xmlopen\xmlns1{\factoidname place}}{\*\xmlopen\xmlns1{\factoidname country-region}}New Zealand{\*\xmlclose}{\*\xmlclose} d ollars) \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7933468\charrsid7410557 \par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid7933468 NZ$ ___________________________________ . ______________ \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7933468\charrsid7410557 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7933468 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid945510 { \fs24\lang2057\langfe1033\langnp2057\insrsid7933468 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid945510 18. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid7410557 If a foreign currency was involved in this transaction, specify:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid945510 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7410557\charrsid7410557 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7410557 Foreign Currency ___________________________________________________________ \par }{\lang2057\langfe1033\langnp2057\insrsid7410557 (eg Hong Kong Dollars)}{\fs24\lang2057\langfe1033\langnp2057\insrsid7410557 \par \par Foreign Currency Amount ____________________________________________________ \par }{\lang2057\langfe1033\langnp2057\insrsid7410557 (eg HKD$400,000)}{\lang2057\langfe1033\langnp2057\insrsid7410557\charrsid7410557 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid7410557\charrsid7410557 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid945510 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid7410557 { \fs24\lang2057\langfe1033\langnp2057\insrsid945510 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15474894 19. If a cheque/bank draft/money order/telegraphic transfer/transfer of currency or purchase or sale of any security was involved in the transaction, please specify:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid7410557 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15474894\charrsid15474894 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15474894 Drawer/Ordering Customer: __________________________________________________ \par \par Payee/Favouree/Beneficiary: __________________________________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid15474894\charrsid15474894 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15474894\charrsid15474894 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid7410557 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid12274321 { \fs24\lang2057\langfe1033\langnp2057\insrsid7410557 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid12274321 20. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid2038495 If another financial institution was involved in this transaction, please specify:}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid12274321 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2038495\charrsid2038495 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2038495 Name of financial institution: _________________________________________________ \par \par _________________________________________________________________________ \par \par Branch: ________________________________ Country: ___________________________}{\fs24\lang2057\langfe1033\langnp2057\insrsid2038495\charrsid2038495 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2038495\charrsid2038495 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid12274321 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15495669 { \fs24\lang2057\langfe1033\langnp2057\insrsid12274321 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid4010714 21. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15495669\charrsid4010714 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15495669 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid7759023 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15801704\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 PART \endash DETAILS OF THE RECIPIENT PERSON/ORGANISATION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr \brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 22. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 23. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 24. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 25. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 26. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15801704\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 PART E \endash GROUNDS FOR SUSPICION}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }\pard\plain \ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid13923593\yts15 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704 27. }{ \b\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid15801704 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \trowd \irow0\irowband0\lastrow \ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13923593\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9108\clshdrawnil \cellx9000\row }\pard \ql \li0\ri0\nowidctlpar\wrapdefault\faauto\adjustright\rin0\lin0\itap0\pararsid15801704 { \fs24\lang2057\langfe1033\langnp2057\insrsid15801704 \par }{\fs24\lang2057\langfe1033\langnp2057\insrsid15801704\charrsid599434 \par }}